University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa.
BMC Health Serv Res. 2018 Jul 11;18(1):539. doi: 10.1186/s12913-018-3278-4.
Global strategies recommend a continuum of care for maternal health to improve outcomes and access to care in low and middle income countries (LMICs). South Africa has already set priority interventions along the continuum of care for maternal health, and mandated their implementation at the district health level. However, the approach for monitoring access to this continuum of care has not yet been defined. This review assessed measurement approaches in continuum of care for maternal health among LMICs and their implications for the South African context.
We conducted a critical interpretive synthesis of quantitative and qualitative research sourced from Academic Search Complete (EBSCO), MEDLINE (Pubmed), Cambridge Journals Online, Credo Reference and Science Direct. We selected 20 out of 118 articles into the analysis, following a rigorous quality appraisal and relevance assessment. The outcomes of the synthesis were new constructs for the measurement of continuum of care for maternal health, derived from the existing knowledge gaps.
We learned that coverage was the main approach for measuring and monitoring the continuum of care for maternal health in LMICs. The measure of effective coverage was also used to integrate quality into coverage of care. Like coverage, there was no uniform definition of effective coverage, and we observed gaps in the measurement of multiple dimensions of quality. From the evidence, we derived a new construct called adequacy that incorporated timeliness of care, coverage, and the complex nature of quality. We described the implications of adequacy to the measurement of the continuum of care for maternal health in South Africa.
Critical interpretive synthesis allowed new understandings of measurement of the continuum of care for maternal health in South Africa. The new construct of adequacy can be the basis of a new measure of access to the continuum of care for maternal health. Although adequacy conceptualizes a more holistic approach, more research is needed to derive its indicators and metrics using South African data sources.
全球战略建议为改善中低收入国家（LMICs）的母婴健康结局和护理获取，为母婴健康提供一个连续的护理服务。南非已经沿着母婴健康连续护理服务的优先干预措施，并且授权在地区卫生一级实施。然而，监测母婴健康连续护理服务获取情况的方法尚未确定。本研究评估了 LMICs 中母婴健康连续护理服务的测量方法及其对南非背景的影响。
我们对来自 Academic Search Complete（EBSCO）、MEDLINE（Pubmed）、剑桥期刊在线、Credo Reference 和 Science Direct 的定量和定性研究进行了批判性综合分析。我们在严格的质量评估和相关性评估后，从 118 篇文章中选择了 20 篇纳入分析。综合分析的结果是源自现有知识空白的母婴健康连续护理服务测量的新构建。
我们了解到，覆盖范围是衡量和监测 LMICs 母婴健康连续护理服务的主要方法。有效覆盖率的衡量标准也被用于将质量纳入护理服务的覆盖范围。与覆盖率一样，有效覆盖率没有统一的定义，我们也观察到了多个质量维度的测量差距。从证据中，我们推导出了一个新的构建，称为充足性，它包含了护理的及时性、覆盖率和质量的复杂性。我们描述了充足性对南非母婴健康连续护理服务测量的影响。
批判性综合分析使我们对南非母婴健康连续护理服务测量有了新的理解。充足性的新构建可以作为母婴健康连续护理服务获取的新测量方法的基础。虽然充足性概念化了更全面的方法，但需要更多的研究使用南非数据源来推导出其指标和度量。
